Clinical outcomes of patients with lower risk myelodysplastic syndrome from <scp>EUMDS</scp> registry eligible for transplantation: Implications for transplantation strategies

Selecting eligible allogeneic haematopoietic stem cell transplantation (allo-HSCT) candidates with low-risk and intermediate-risk myelodysplastic syndrome (MDS) remains controversial. The International Working Group (IWG) for MDS prognosis identified a Revised International Prognostic Scoring System (IPSS-R) score >3.5 for benefits from early transplantation; the MDS-RIGHT group uses a broader set of poor risk features. We analysed 1145 lower risk MDS (lower risk and intermediate-risk IPSS-R) patients aged <75 years, using real-world European Myelodysplastic Syndromes registry data and identifying those meeting IWG or MDS-RIGHT criteria for allo-HSCT at baseline and 6-month follow-up. Fit patients were characterised by Karnofsky score ≥70 and Haematopoietic Cell Transplantation-specific Comorbidity Index <3. We evaluated clinical outcomes of transplant candidates, including survival, disease progression risk, new comorbidity risk and performance status decline. The IWG criterion, and not MDS-RIGHT criteria, identified patients with lower risk and intermediate-risk MDS with poorer baseline survival. Fit lower risk patients showed 2-year cumulative risks of incident comorbidity and performance status deterioration of 20% and 5% respectively. In summary, IWG and MDS-RIGHT features identify patients with lower or intermediate-risk MDS as candidates for early transplantation. Lower risk patients fit for transplantation have a cumulative incidence of adverse outcomes possibly jeopardising transplantation eligibility and should be carefully selected when planning delayed transplantation strategies.

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Publication Details

Journal
British Journal of Haematology
Published
2026-02-18
DOI
https://doi.org/10.1111/bjh.70384
Primary Topic
Acute Myeloid Leukemia Research
Type
article
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article

Clinical outcomes of patients with lower risk myelodysplastic syndrome from EUMDS registry eligible for transplantation: Implications for transplantation strategies

S. Crouch, Verena Petzer, L. Malcovati, Argiris Symeonidis et al.
British Journal of Haematology
Acute Myeloid Leukemia Research
article

Clinical outcomes of patients with lower risk myelodysplastic syndrome from EUMDS registry eligible for transplantation: Implications for transplantation strategies

S. Crouch, Verena Petzer, L. Malcovati, Argiris Symeonidis, Panagiotis Panagiotidis, Aleksandar Savić, Catherine Cargo, Saskia Langemeijer, Jaroslav Čermák, Corine J. van Marrewijk, Guillermo Sanz, Moshe Mittelman, Pierre Fenaux, Theo de Witte, Eva Hellström‐Lindberg, Maud D'Aveni, Adele Taylor, Thibault Comont, the EUMDS registry, Dominic Culligan, Ioannis Kotsianidis, Alexandra Smith
article en

Abstract

Selecting eligible allogeneic haematopoietic stem cell transplantation (allo-HSCT) candidates with low-risk and intermediate-risk myelodysplastic syndrome (MDS) remains controversial. The International Working Group (IWG) for MDS prognosis identified a Revised International Prognostic Scoring System (IPSS-R) score >3.5 for benefits from early transplantation; the MDS-RIGHT group uses a broader set of poor risk features. We analysed 1145 lower risk MDS (lower risk and intermediate-risk IPSS-R) patients aged <75 years, using real-world European Myelodysplastic Syndromes registry data and identifying those meeting IWG or MDS-RIGHT criteria for allo-HSCT at baseline and 6-month follow-up. Fit patients were characterised by Karnofsky score ≥70 and Haematopoietic Cell Transplantation-specific Comorbidity Index <3. We evaluated clinical outcomes of transplant candidates, including survival, disease progression risk, new comorbidity risk and performance status decline. The IWG criterion, and not MDS-RIGHT criteria, identified patients with lower risk and intermediate-risk MDS with poorer baseline survival. Fit lower risk patients showed 2-year cumulative risks of incident comorbidity and performance status deterioration of 20% and 5% respectively. In summary, IWG and MDS-RIGHT features identify patients with lower or intermediate-risk MDS as candidates for early transplantation. Lower risk patients fit for transplantation have a cumulative incidence of adverse outcomes possibly jeopardising transplantation eligibility and should be carefully selected when planning delayed transplantation strategies.

British Journal of Haematology
Innsbruck Medical University (AT), Radboud University Nijmegen (NL), Democritus University of Thrace (GR), University of Novi Sad (RS), University of Patras (GR), National and Kapodistrian University of Athens (GR), Université Paris Cité (FR), University of Pavia (IT), Leeds Teaching Hospitals NHS Trust (GB), Tel Aviv Sourasky Medical Center (IL), Aberdeen Royal Infirmary (GB), St James's University Hospital (GB), General University Hospital of Patras (GR), Radboud University Medical Center (NL), Karolinska Institutet (SE), Hospital Universitari i Politècnic La Fe (ES), Centre Hospitalier Universitaire de Toulouse (FR), Institute of Haematology and Blood Transfusion (CZ), Institut universitaire du cancer de Toulouse Oncopole (FR), Patras Olympian Hospital (GR), Radboud Institute for Molecular Life Sciences (NL), Laiko General Hospital of Athens (GR), Leitat Technological Center (ES), Hôpital Saint-Louis (FR), Policlinico San Matteo Fondazione (IT), Centro de Investigación Biomédica en Red de Cáncer (ES), University Hospital of Alexandroupolis (GR), Instituto de Investigación Sanitaria La Fe (ES), University of York (GB), Université de Lorraine (FR)
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Acute Myeloid Leukemia Research
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